title: Clinical features and treatment of ulcerative colitis-related severe gastroduodenitis and enteritis with massive bleeding after colectomy.
abstract: BACKGROUND
  Ulcerative colitis (UC) has been recognised as a systemic immune disorder that is not as restricted as colitis. UC-related gastrointestinal lesions with bleeding can develop soon after colectomy and can progress rapidly. Therefore, we considered the clinical features and treatment of these UC-related lesions.
  
  
  METHODS
  We reviewed the patient data in our UC surgery database to evaluate its prevalence and features.
  
  
  RESULTS
  We found 7/1,100 patients with UC-related lesions between January 2000 and April 2013. These lesions developed at a mean of 24 (range 8-480) days after colectomy. Six of the seven patients suffered from gastrointestinal bleeding as an initial symptom that rapidly developed into massive bleeding or perforations. All of the patients were diagnosed with pancolitis; at the time of colectomy, fulminant, severe, moderate, and mild colitis were presented by four, one, one, and one patients, respectively. All patients with enteritis had consecutively developed other infectious complications, including anastomotic leakage, pyoderma gangrenosum, wound infection, and pneumonia. Although patients with bleeding did not respond to treatment with corticosteroids, they responded well to infliximab soon after its administration. Although six of the seven patients showed cytomegalo virus re-activation in blood or pathological examinations, ganciclovir was not effective in its elimination.
  
  
  CONCLUSIONS
  Although UC-related lesions with an unknown aetiology can occur after colectomy, immediate examination and treatment are required if gastrointestinal bleeding is found after surgery. Because gastrointestinal bleeding from UC-related lesions can worsen rapidly and may be related to mortality, early potent immunosuppressive therapy should be considered.
authors.affiliation: Department of Lower Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan, uchino2s@hyo-med.ac.jp.
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirata
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Kei
authors.initials: K
authors.lastname: Hirose
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamura
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D003587:Cytomegalovirus / Q000502:physiology; D004382:Duodenitis / Q000209:etiology* / Q000473:pathology* / Q000628:therapy / Q000821:virology; D005260:Female; D005756:Gastritis / Q000209:etiology* / Q000473:pathology* / Q000628:therapy / Q000821:virology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000628:therapy / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult